Sunday, 14 March 2010

MOUTH CARE

Given in the morning, at bedtime, or after meals, mouth care entails brushing and flossing the teeth and inspecting the mouth. It removes soft plaque deposits and calculus from the teeth, cleans and massages the gums, reduces mouth odor, and helps prevent infection. By freshening the patient's mouth, mouth care also enhances appreciation of food, thereby aiding appetite and nutrition.
Although the ambulatory patient can usually perform mouth care alone, the bedridden patient may require partial or full assistance. The comatose patient requires the use of suction equipment to prevent aspiration during oral care.
Equipment
Towel or facial tissues • emesis basin • trash bag • mouthwash • toothbrush and toothpaste • pitcher and glass • drinking straw • dental floss • gloves • small mirror, if necessary • optional: dental floss holder, oral irrigating device.
For the comatose or debilitated patient as needed
Linen-saver pad • bite-block • petroleum jelly • hydrogen peroxide • sponge-tipped mouth swab • oral suction equipment or gauze pads • optional: lemon-glycerin swabs or mouth-care kit, tongue blade, 4″ gauze pads, adhesive tape.
Preparation of equipment
Fill a pitcher with water and bring it and other equipment to the patient's bedside. If you'll be using oral suction equipment, connect the tubing to the suction bottle and suction catheter, insert the plug into an outlet, and check for correct operation. If necessary, devise a bite-block to protect yourself from being bitten during the procedure. Wrap a gauze pad over the end of a tongue blade, fold the edge in, and secure it with adhesive tape.
Implementation
  • Wash your hands thoroughly, put on gloves, explain the procedure to the patient, and provide privacy.
Supervising mouth care
  • For the bedridden patient capable of self-care, encourage him to perform his own mouth care.
  • If allowed, place the patient in Fowler's position. Place the overbed table in front of the patient, and arrange the equipment on it. Open the table and set up the built-in mirror, if available, or position a small mirror on the table.
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  • Drape a towel over the patient's chest to protect his gown. Tell him to floss his teeth while looking into the mirror.
  • Observe the patient to make sure he's flossing correctly, and correct him if necessary. Tell him to wrap the floss around the second or third fingers of both hands. Starting with his front teeth and without injuring the gums, he should insert the floss as far as possible into the space between each pair of teeth. Then he should clean the surfaces of adjacent teeth by pulling the floss up and down against the side of each tooth. After the patient flosses a pair of teeth, remind him to use a clean 1″ (2.5 cm) section of floss for the next pair.
  • After the patient flosses, mix mouthwash and water in a glass, place a straw in the glass, and position the emesis basin nearby. Then instruct the patient to brush his teeth and gums while looking into the mirror. Encourage him to rinse frequently during brushing, and provide facial tissues for him to wipe his mouth.

Performing mouth care
  • For the comatose patient or the conscious patient incapable of self-care, you'll perform mouth care. If the patient wears dentures, clean them thoroughly. (See Dealing with dentures.) Some patients may benefit from using an oral irrigating
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    device such as a Water Pik. (See Using an oral irrigating device.)
  • Raise the bed to a comfortable working height to prevent back strain. Then lower the head of the bed, and position the patient on his side, with his face extended over the edge of the pillow to facilitate oral drainage and prevent fluid aspiration.
  • Arrange the equipment on the overbed table or bedside stand, including the oral suction equipment, if necessary. Turn on the machine. If a suction machine isn't available, wipe the inside of the patient's mouth frequently with a gauze pad.
  • Place a linen-saver pad under the patient's chin and an emesis basin near his cheek to absorb or catch oral drain-age.
  • Lubricate the patient's lips with petroleum jelly to prevent dryness and cracking. Reapply lubricant, as needed, during oral care.
  • If necessary, insert the bite-block to hold the patient's mouth open during oral care.
  • Using a dental floss holder, hold the floss against each tooth and direct it as close to the gum as possible without injuring the sensitive tissues around the tooth.
  • After flossing the patient's teeth, mix mouthwash and water in a glass and place the straw in it.
  • Wet the toothbrush with water. If necessary, use hot water to soften the bristles. Apply toothpaste.
  • Brush the patient's lower teeth from the gum line up; the upper teeth, from the gum line down. Place the brush at a 45-degree angle to the gum line, and press the bristles gently into the gingival sulcus. Using short, gentle strokes to prevent gum damage, brush the facial surfaces (toward the cheek) and the lingual surfaces (toward the tongue) of the bottom teeth. Use just the tip of the brush for the lingual surfaces of the front teeth. Then, using the same technique, brush the facial and lingual surfaces of the top teeth. Next, brush the biting
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    surfaces of the bottom and top teeth, using a back and forth motion. If possible, ask the patient to rinse frequently during brushing by taking the mouthwash solution through the straw. Hold the emesis basin steady under the patient's cheek, and wipe his mouth and cheeks with facial tissues as needed.
  • After brushing the patient's teeth, dip a cotton-tipped mouth swab into the mouthwash solution. Press the swab against the side of the glass to remove excess moisture. Gently stroke the gums, buccal surfaces, palate, and tongue to clean the mucosa and stimulate circulation. Replace the swab as necessary for thorough cleaning. Avoid inserting the swab too deeply to prevent gagging and vomiting.
After mouth care
  • Assess the patient's mouth for cleanliness and tooth and tissue condition.
  • Then remove your gloves, rinse the toothbrush, and clean the emesis basin and glass. Empty and clean the suction bottle, if used, and place a clean suction catheter on the tubing. Return reusable equipment to the appropriate storage location, and properly discard disposable equipment in the trash bag.
Special considerations
  • Use sponge-tipped mouth swabs to clean the teeth of a patient with sensitive gums. These swabs produce less friction than a toothbrush but don't clean as well.
  • Clean the mouth of a toothless comatose patient by wrapping a gauze pad around your index finger, moistening it with mouthwash, and gently swabbing the oral tissues. If necessary, moisten gauze pads in an equal mixture of hydrogen peroxide and water to remove tenacious mucus.
  • Remember that mucous membranes dry quickly in the patient breathing through his mouth or receiving oxygen therapy. Moisten his mouth and lips regularly with moistened sponge-tipped swabs, or water. If you use water as the lubricant, place a short straw in a glass of water and stop the open end with your finger. Remove the straw from the water and, with your finger in place, position it in the patient's mouth. Release your finger slightly to let the water flow out gradually. If the patient is comatose, suction excess water to prevent aspiration.
Documentation
Record the date and time of mouth care in your notes. Also note any unusual conditions, such as bleeding, edema, mouth odor, excessive secretions, or plaque on the tongue.